Background: Failed hypospadias refers to any hypospadias repair that leads to complicationsor causes patient dissatisfaction. One of the commonest major complications of hypospadias surgery is urethrocutaneous fistula. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistentlarge (>4mm) or multiple -small (<4mm) fistulae, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of five years (from July 2011 to June, 2016). A total of 189 patients were included in present study and randomized in the three groups under study. Comparisons were made among three procedures of salvage urethroplasty of failed hypospadias caused by urethrocutaneous fistula using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft (group A) than flip flap(group C) and dorsal transposition flap (group B ). This led to a higher success rate and better patient compliance in buccal mucosal graft. The objective scoring evaluation revealed that score gain of BM group (182) was significantly higher than that of dorsal transposition flap (112) and flip flap (89) at P value <0.05 . Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C). TAJ 2018; 31(1): 38-45
Background: Sigmoid volvulus occurs when the sigmoid colon twists on its mesentery and is a cause of intestinal obstruction. Method: This was a descriptive study conducted at the Surgery department of Rajshahi Medical College Hospital during the period from May 2009 to June 2011. Ethical consideration was taken from all the patients. The sample size was 50 with acute sigmoid volvulus. Data were processed and analyzed through SPSS (Statistical package for social sciences). A value of p ≤0.05 was considered significant statistically. Result: Most patients (56%) were diagnosed with acute sigmoid volvulus from the age range of 51-60, among whom male patients had a prevalence (92%). Most of them (92%) were economically impoverished. 36% of patients came to the hospital for treatment from 37-48 hours of illness. The post-operative complication was mild due to wound infection in 10% of patients. Hospital stay was 8-10 days for 76% of patients without complications postoperatively and 11-13 days for 14% of patients. Severe complication Resulting in hospital stay was seen in 4% of patients. Conclusion: Emergency resection of the sigmoid colon and anastomosis in unprepared bowel was an attractive and preferred option in a setting where patients are poor, hospital care often unaffordable and hospital beds are few. TAJ 2022; 35: No-2: 13-18
Introduction: Splenectomy has long been used to treat benign hematological abnormalities such as immune thrombocytopenia (ITP), some hemolytic anemias- especially hereditary spherocytosis and thalassemia, and prehepatic portal hypertension. The discovery that splenectomized individuals are more vulnerable to encapsulated organism infection has been attributed to the spleen's lack of filtration and the development of anticarbohydrate antibodies. Recent research in such splenectomized patients suggests that the lack of this specific anticarbohydrate antibody in these participants is attributable to a decreased number of Memory B cells (a subgroup of B lymphocytes in charge of T-independent responses). Traditional vaccinations, which are given to splenectomized patients to protect them from being infected by encapsulated organisms, can only act in the presence of both the spleen and its functioning marginal zone. As a Result, the study will look at the level of memory B cells in the blood after three months and 1-year post-splenectomy. Aim of the study: The objective of the study was to observe the short- and long-term effects of splenectomy on memory B cells in children. Methods: This prospective case-control study was conducted at the Pediatric Surgery Department of Bangabandhu Sheikh Mujib Medical University, Bangladesh. The study duration was one year, from July 2015 to August 2016. A total of 26 children were selected through a purposive sampling technique for this study, where the control group consisted of 10 children, and the case group consisted of 16 splenectomized children. Result: Among the case group participants, 56.25% were from the oldest age group of 12-15 years, and 37.5% were from the age group of 8-11-years. Male prevalence was high in both the control and the case group. Beta thalassemia was the primary indication for splenectomy for 81.25% of case group patients. Mean B lymphocyte was 39700.2 in the control group, 3655.3 at the 3-month follow-up of case group participants, and 3381.7 for those who had follow-up1-year after splenectomy. The mean amount of IgM memory B cells in the control group was 17.92%; at the 3-month follow-up of the case, it was 18.96%, and at the 1-year follow-up, it was 4.34%. Conclusion: In post-splenectomy individuals, immunological constitutions in memory B cells do not support a T-independent response and, therefore, vaccination. TAJ 2022; 35: No-1: 39-44
Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in pediatric age group, by a randomized comparison. Materials and methods: This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation was significantly less. Conclusion: Laparoscopic sac excision in indirect pediatric inguinal hernia is safe. The procedure is not associate TAJ 2020; 33(2): 20-26
Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation, is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in paediatric age group, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation were significantly less. Conclusion: Laparoscopic sac excision in indirect paediatric inguinal hernia is safe. The procedure is not associated with early recurrence when it is performed in cases with deep ring diameter less than 10mm.
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